Utilization Review RN

2 months ago

Cedar Crest, United States University of New Mexico Full time

Utilization Review RN

We are seeking a highly skilled Registered Nurse to join our Utilization Review team. In this role, you will review all hospital admissions and continued stays for medical necessity and manage insurance authorizations throughout the patient's stay. You will coordinate patient care and ensure quality, cost-effective care for the identified patient population. The ideal candidate will have a Bachelor's degree in Nursing and at least 1 year of directly related experience. Bilingual in English and Navajo is desirable but not required.

Responsibilities:

  • Conduct initial and ongoing assessments to manage the course of treatment and ensure quality, patient-centered outcomes within established time frames and with efficient utilization of resources.
  • Determine and manage outcomes, ensure continuity of care through discharge planning, utilization of resources and analysis of variances.
  • Function as a contact person for patients, families, healthcare team members, community resources and employees as necessary.
  • Coordinate and evaluate the use of resources and services in a quality-conscious, cost-effective manner and collaborate with appropriate providers to ensure effective, quality outcomes.
  • Participate in continuous quality improvement activities by evaluating patient care systems that may include standards, protocols, and documentation.
  • Ensure adherence to Hospitals and departmental policies and procedures.

Qualifications:

  • Graduate of a nationally accredited nursing program.
  • Active RN license in NM or reciprocal agreement state.
  • CPR for Healthcare/BLS provider or Professional Rescuers certification within 30 days of hire.

Physical and Working Conditions:

  • Light work with occasional exertion of force up to 20 pounds, including walking/standing/sitting for long periods.
  • May involve minor hazards such as physical risks, dirt, dust, fumes, and noise.
  • Working schedule is rotating and on an as-needed basis.

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